title: A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients.
abstract: BACKGROUND
  Inflammation has a critical role in the pathogenesis and progression of cancer. Recently, the derived neutrophil to lymphocyte ratio (absolute count of neutrophils divided by the absolute white cell count minus the absolute count of neutrophils; dNLR) has been shown to influence clinical outcome in various cancer entities. In this study, we analysed the dNLR with clinical outcome in stage II and III colon cancer patients.
  
  
  METHODS
  Three-hundred and seventy-two patients with stage II and III colon cancer were included in this retrospective study. Kaplan-Meier curves and multivariate Cox proportion analyses were calculated for time to recurrence (TTR) and overall survival (OS).
  
  
  RESULTS
  In univariate analysis, the elevated preoperative dNLR was significantly associated with decreased TTR (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.57-3.6, P<0.001) and remained significant in multivariate analysis. Patients with dNLR >3 had a median TTR of 83 months, and patients with dNLR ≤ 3 showed a median TTR of 132 months. In OS analysis, a dNLR >2.2 was significantly associated with decreased OS in univariate (HR 1.85, 95% CI 1.11-3.08, P=0.018) and multivariate analysis. Patients with dNLR >2.2 showed a median OS of 121 months, and patients with dNLR ≤ 2.2 had a median OS of 147 months.
  
  
  CONCLUSIONS
  The dNLR may be an independent prognostic marker for TTR and OS in patients with stage II and III colon cancer. Independent validation of our findings is warranted.
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Absenger
authors.forename: J
authors.initials: J
authors.lastname: Szkandera
authors.forename: M
authors.initials: M
authors.lastname: Pichler
authors.forename: M
authors.initials: M
authors.lastname: Stotz
authors.forename: F
authors.initials: F
authors.lastname: Arminger
authors.forename: M
authors.initials: M
authors.lastname: Weissmueller
authors.forename: R
authors.initials: R
authors.lastname: Schaberl-Moser
authors.forename: H
authors.initials: H
authors.lastname: Samonigg
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.forename: A
authors.initials: A
authors.lastname: Gerger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis